Negative Binominal Regression Research Articles

In-Hospital Delirium and Disability and Cognitive Impairment After COVID-19 Hospitalization.

Older adults who are hospitalized for COVID-19 are at risk of delirium. Little is known about the association of in-hospital delirium with functional and cognitive outcomes among older adults who have survived a COVID-19 hospitalization. To evaluate the association of delirium with functional disability and cognitive impairment over the 6 months after discharge among older adults hospitalized with COVID-19. This prospective cohort study involved patients aged 60 years or older who were hospitalized with COVID-19 between June 18, 2020, and June 30, 2021, at 5 hospitals in a major tertiary care system in the US. Follow-up occurred through January 11, 2022. Data analysis was performed from December 2022 to February 2024. Delirium during the COVID-19 hospitalization was assessed using the Chart-based Delirium Identification Instrument (CHART-DEL) and CHART-DEL-ICU. Primary outcomes were disability in 15 functional activities and the presence of cognitive impairment (defined as Montreal Cognitive Assessment score <22) at 1, 3, and 6 months after hospital discharge. The associations of in-hospital delirium with functional disability and cognitive impairment were evaluated using zero-inflated negative binominal and logistic regression models, respectively, with adjustment for age, month of follow-up, and baseline (before COVID-19) measures of the respective outcome. The cohort included 311 older adults (mean [SD] age, 71.3 [8.5] years; 163 female [52.4%]) who survived COVID-19 hospitalization. In the functional disability sample of 311 participants, 49 participants (15.8%) experienced in-hospital delirium. In the cognition sample of 271 participants, 31 (11.4%) experienced in-hospital delirium. In-hospital delirium was associated with both increased functional disability (rate ratio, 1.32; 95% CI, 1.05-1.66) and increased cognitive impairment (odds ratio, 2.48; 95% CI, 1.38-4.82) over the 6 months after discharge from the COVID-19 hospitalization. In this cohort study of 311 hospitalized older adults with COVID-19, in-hospital delirium was associated with increased functional disability and cognitive impairment over the 6 months following discharge. Older survivors of a COVID-19 hospitalization who experience in-hospital delirium should be assessed for disability and cognitive impairment during postdischarge follow-up.

Maternal intake of paracetamol during pregnancy and biomarkers of male fecundity in young adult sons

Paracetamol is suggested to have endocrine disrupting properties possibly affecting fetal programming of reproductive health that might lead to impaired semen quality and changes in reproductive hormones. In this longitudinal study, we included 1058 young adult men born 1998–2000 into the Danish National Birth Cohort with follow-up at 18–21 years of age. The exposure, maternal intake of paracetamol, was modelled in three ways: dichotomized, trimester-specific, and as duration of exposure categorized into: short (1–2 weeks), medium (3–9 weeks) or long duration (>9 weeks) vs. no intake. Outcomes included semen characteristics, self-measured testis volume, and reproductive hormone levels. We used negative binominal regression to estimate the percentage difference and 95% confidence interval (CI) for each outcome. In total, 547 (48%) sons were prenatally exposed to paracetamol due to maternal intake at least once. Maternal intake of paracetamol during pregnancy was not associated with any of the biomarkers in the dichotomized or trimester-specific exposure models. For duration of exposure, sons of mothers with long duration of maternal intake of paracetamol showed tendencies towards lower semen concentration (-14% [95% CI: -31%; 8%]), a higher proportion of nonprogressive and immotile spermatozoa (8% [95% CI: -4%; 21%]) and higher DNA Fragmentation Index (16% [95% CI: -1%; 36%]) compared to son of mothers with no intake. Maternal intake of paracetamol during pregnancy was not clearly associated with biomarkers of male fecundity in adult sons. However, it cannot be ruled out that long duration of maternal intake of paracetamol might be associated with impaired semen characteristics.

An Officer-Level Examination of the Prevalence and Correlates of Police Body-Worn Camera Activation

Body-worn cameras (BWCs) are intended to promote transparency and accountability. However, officer failure to activate BWCs remains a concern. Research has identified types of incidents associated with activation failure, but has not examined activation as a measure of performance. We examine BWC activation as an officer-level decision-making process, assessing the influence of demographics, assignments, and performance (e.g., proactivity) on activation rates over time. Negative binominal and multinomial logistic regression were used to analyze data from 149 officers assigned to wear BWCs during a randomized-controlled trial. Activation rates ranged from 0–88% of calls-for-service. Group-based trajectory modeling identified three activation trends: decreased, increased then decreased, and increased and tapered off. Limited relationships between officer-level predictors and activation were identified. Findings suggest officer characteristics and performance are not primary drivers of BWC activation. Departments should use supervision, retraining, and policy intervention to ensure BWCs are implemented as intended.

Time interval between the onset of symptoms and diagnosis of multiple sclerosis and the influential factors: A national registry-based study

ObjectiveThe time to diagnosis of multiple sclerosis (MS) is of great importance for early treatment, thereby reducing the disability and burden of the disease. The purpose of this study was to determine the time from the onset of clinical symptoms to the diagnosis of MS and to evaluate the factors associated with a late diagnosis in Iranian MS patients. MethodsThe present cross-sectional study was conducted on patients with MS who were registered in the National MS Registry System of Iran (NMSRI). ResultsOverall, 23291 MS patients registered in 18 provinces of Iran were included in this study. The mean (standard deviation) interval between the onset of the disease and diagnosis of MS was 13.42 (32.40) months, and the median was one month. The diagnostic interval of 41.6% of patients was less than one month, and 14.8% of them had a one-month time to diagnosis. Patients with an age of onset below 18 years and those diagnosed after the age of 50 years had a longer time to diagnosis (P<0.001). Patients with primary progressive MS (PPMS) had the longest time to diagnose and those with relapsing-remitting MS (RRMS) had the shortest time (P<0.001). The results of negative binominal regression showed that the average rate of delay in diagnosis in women was 12% less than that in men. The average delay in diagnosis in patients with a positive family history of MS was 23% more than that in others. The rate of delay in the diagnosis of patients with PPMS and secondary progressive MS was 2.22 and 1.66 times higher, respectively, compared with RRMS. ConclusionThe findings of the present study revealed that more than half of the MS patients were diagnosed within a one-month interval from the symptom onset, which is an acceptable period. More attention should be paid to patients’ access to medical facilities and MS specialists.

Examining the association of rurality with opioid-related morbidity and mortality in Georgia: A geospatial analysis

IntroductionThe US opioid epidemic continues to escalate, with overdose deaths being the most-used metric to quantify its burden. There is significant geographic variation in opioid-related outcomes. Rural areas experience unique challenges, yet many studies oversimplify rurality characterizations. Contextual factors, such as area deprivation, are also important to consider when understanding a community's need for treatment services and prevention programming. This study aims to provide a geospatial snapshot of the opioid epidemic in Georgia using several metrics of opioid-related morbidity and mortality and explore differences by rurality across counties. MethodsThis was a spatial ecologic study. Negative binominal regression was used to model the relationship of county rurality with four opioid-related outcomes – overdose mortality, emergency department visits, inpatient hospitalizations, and overdose reversals - adjusting for county-level sex, racial/ethnic, and age distributions. Area Deprivation Index was also included. ResultsThere was significant geographic variation across the state for all four opioid-related outcomes. Counts remained highest among the metro areas. For rates, counties in the top quartile of rates varied by outcome and were often rural areas. In the final models, rurality designation was largely unrelated to opioid outcomes, with the exception of medium metro areas (inversely related to hospitalizations and overdose reversals) and non-core areas (inversely related to hospitalizations), as compared to large central metro areas. Higher deprivation was significantly related to increased ED visits and hospitalizations, but not overdose mortality and reversals. ConclusionsWhen quantifying the burden of the opioid epidemic in a community, it is essential to consider multiple outcomes of morbidity and mortality. Understanding what outcomes are problematic for specific communities, in combination with their demographic and socioeconomic context, can provide insight into gaps in the treatment continuum and potential areas for intervention. Additionally, compared to demographic and socioeconomic factors, rurality may no longer be a salient predictor of the severity of the opioid epidemic in an area.

Correlates of Cannabis Use and Self-Control Across a Diverse Sample of College Students: 2020-2022.

Despite the established relationship between substance use and self-control, it is unknown how the COVID-19 pandemic may have played a role in this association. Given the unique circumstances of the pandemic along with changing societal regulations surrounding cannabis use, and their collective impact on college students, there is a need to examine the relationship between cannabis and self-control during the pandemic era. Data was collected from a repeated cross-sectional sample of college students at a mid-sized, urban U.S. institution during 2020-2022. Logistic and negative binominal regression analyses along with an ANCOVA were conducted to examine associations between self-control and past 30-day cannabis use. Lower self-control was significantly associated with using cannabis in the past 30-days with those individuals with self-reported low self-control using cannabis significantly more and more times per day. Finally, we found that both past 30-day cannabis use and cohort significantly predicted self-control with both individuals who report past 30-day cannabis use and the 2020 cohort reporting lower levels of self-control. There was not a significant interaction effect. Despite evolving legislation regarding both medicinal and recreational cannabis use, colleges often maintain drug-free campus policies. Given high rates of cannabis use among college students and continued development of self-control, this association should be examined longitudinally and considered when creating college-level cannabis policies. Implications for college students surrounding COVID-era environments, and self-control are discussed.

Contralateral Arm Pain as a Sign of Distress Regarding Symptoms

Background: Pain intensity and magnitude of incapability are associated with common unhelpful thoughts about symptoms such as catastrophic thinking and kinesiophobia. To determine whether reports of pain in the upper limb contralateral to a non-trauma condition were associated with unhelpful thoughts, we measured the relationship between pain intensity in the opposite limb and levels of unhelpful thinking. Methods: In a cross-sectional study, 152 new and return patients seeking care of an upper-limb musculoskeletal condition completed measures of upper-extremity-specific magnitude of capability, pain intensity of the involved and contralateral arms, unhelpful thoughts regarding symptoms, symptoms of distress regarding symptoms, and general symptoms of depression. Factors associated with contralateral and ipsilateral pain intensity and upper-extremity-specific magnitude of capability were assessed using multivariable statistics. Results: In bivariate analysis, contralateral arm pain was associated with symptoms of distress regarding pain, but not in multivariable analysis. Accounting for potential confounding in negative binominal regression analysis, greater pain intensity of the affected side was independently associated with greater feelings of distress regarding symptoms and no prior surgery. Greater upper-extremity-specific capability was independently associated with less distress regarding symptoms, married/partnered, men, and no prior surgery. Conclusions: The observation that greater pain intensity in the opposite arm was associated with greater distress regarding symptoms suggests that, in combination with other verbal and non-verbal signs of distress, patient concerns about pain in the contralateral limb can help direct patients and surgeons to evidence-based care strategies for alleviating stress regarding symptoms.

Government venture capital and innovation performance in alternative energy production: The moderating role of environmental regulation and capital market activity

Energy shortages and environmental concerns have prompted governments to focus on alternative energy production innovation. Although studies examine the association between government venture capital and green innovation, there remains a gap in understanding how the different characteristics of government venture capital affect innovation. This study examines the effects of government venture capital on the innovation performance of alternative energy production. Using negative binominal regression and system generalised method of moments models with data from 30 provinces in China for the period spanning from 2003 to 2019, we find that government venture capital exerts an inverted U-shaped effect on the innovation performance of alternative energy production. In addition, environmental regulation strengthens this inverted U-shaped effect, while capital market activity alleviates it. Moreover, we confirm that government venture capital affects alternative energy production innovation through the R&D investment channel. Our study enriches the resource-based view, agency theory and the institution-based view by shedding light on how the different characteristics of government venture capital affect alternative energy production innovation. The findings suggest that policymakers should strike a balance between government intervention and market mechanisms.

Income-based differences in healthcare utilization in relation to mortality in the Swedish population between 2004–2017: A nationwide register study

Background Despite universal healthcare, socioeconomic differences in healthcare utilization (HCU) persist in modern welfare states. However, little is known of how HCU inequalities has developed over time. The aim of this study is to assess time trends of differences in utilization of primary and specialized care for the lowest (Q1) and highest (Q5) income quantiles and compare these to mortality. Methods and findings Using a repeated cross-sectional register-based study design, data on utilization of (i) primary; (ii) specialized outpatient; and (iii) inpatient care, as well as (iv) cause of death, were linked to family income and sociodemographic control variables (for instance, country of origin and marital status). The study sample comprised all individuals 16 years or older residing in Sweden any year during the study period and ranged from 7.1 million in year 2004 to 8.0 million year 2017. HCU and mortality for all disease as well as for the 5 disease groups causing most deaths were compared for the Q1 and Q5 using logistic regression, adjusting for sex, age, marital status, and birth country. The primary outcome measures were adjusted odds ratios (ORs), and regression coefficients of annual changes in these ORs log-transformed. Additionally, we conducted negative binominal regression to calculate adjusted rate ratios (RRs) comparing Q1 and Q5 with regard to number of disease specific healthcare encounters ≤5 years prior to death. In 2017, for all diseases combined, Q1 utilized marginally more primary and specialized outpatient care than Q5 (OR 1.07, 95% CI [1.07, 1.08]; p &lt; 0.001, and OR 1.04, 95% CI [1.04, 1.05]; p &lt; 0.001, respectively), and considerably more inpatient care (OR 1.44, 95% CI [1.43, 1.45]; p &lt; 0.001). The largest relative inequality was observed for mortality (OR 1.78, 95% CI [1.74, 1.82]; p &lt; 0.001). This pattern was broadly reproduced for each of the 5 disease groups. Time trends in HCU inequality varied by level of care. Each year, Q1 (versus Q5) used more inpatient care and suffered increasing mortality rates. However, utilization of primary and specialized outpatient care increased more among Q5 than in Q1. Finally, group differences in number of healthcare encounters ≤5 years prior to death demonstrated a similar pattern. For each disease group, primary and outpatient care encounters were fewer in Q1 than in Q5, while inpatient encounters were similar or higher in Q1. A main limitation of this study is the absence of data on self-reported need for care, which impedes quantifications of HCU inequalities each year. Conclusions Income-related differences in the utilization of primary and specialized outpatient care were considerably smaller than for mortality, and this discrepancy widened with time. Facilitating motivated use of primary and outpatient care among low-income groups could help mitigate the growing health inequalities.

Investigating social deprivation and comorbid mental health diagnosis as predictors of treatment access among patients with an opioid use disorder using substance use services: a prospective cohort study

BackgroundOpioid use is a major public health concern across the globe. Opioid use and subsequent access to care is often shaped by co-occurring issues faced by people using opioids, such as deprivation, mental ill-health, and other forms of substance use. We investigated the role of social deprivation and comorbid mental health diagnoses in predicting re-engagement with substance use services or contact with crisis and inpatient services for individuals with opioid use disorder in secondary mental health care in inner-city London.MethodsWe conducted a prospective cohort study which followed individuals diagnosed with a first episode of opioid use disorder who accessed substance use services between September 2015 and May 2020 for up to 12 months, using anonymised electronic health records. We employed negative binominal regression and Cox proportional survival analyses to assess associations between exposures and outcomes.ResultsComorbid mental health diagnoses were associated with higher contact rates with crisis/inpatient services among people with opioid use disorder: incidence rate ratios (IRR) and 95% confidence intervals (CI) were 3.91 (1.74–9.14) for non-opioid substance use comorbidity, 8.92 (1.81–64.4) for a single comorbid mental health diagnosis, and 15.9 (5.89–47.5) for multiple comorbid mental health diagnoses. Social deprivation was not associated with contact rates with crisis/inpatient services within this sample. Similar patterns were found with time to first crisis/inpatient contact. Social deprivation and comorbid mental health diagnoses were not associated with re-engagement with substance use services.ConclusionComorbid substance and mental health difficulties amongst people with an opioid use disorder led to earlier and more frequent contact with crisis/inpatient mental health services during the first 12 months of follow up. Given the common co-occurrence of mental health and substance use disorders among those who use opioids, a better understanding of their wider needs (such as social, financial and other non-medical concerns) will ensure they are supported in their treatment journeys.

Associations of adverse childhood experiences with caries and toothbrushing in adolescents. The Young-HUNT4 Survey

BackgroundAdverse childhood experiences (ACEs) are associated with poor oral health. Using a life course theoretical framework, this study explored the associations of specific and cumulative ACEs with caries and toothbrushing frequency in a Norwegian adolescent population.MethodsParticipants were adolescents (n = 6351) age 13–17 years from The Young-HUNT4 Survey. Clinical data were retrieved from dental health records. Oral health outcomes were toothbrushing frequency, dentine caries experience (Decayed, Missing, and Filled Teeth – DMFT), and enamel caries. ACE exposure variables were physical abuse, sexual abuse, witness to violence, parental separation/divorce, parental alcohol problems, and bully victimization. Negative binominal regression models (incident rate ratios, IRRs; 95% confidence intervals, CIs) were used to determine the associations of the various ACEs with caries; logistic regression analyses (odds ratios, ORs; 95% CIs) were used to estimate associations with toothbrushing frequency. Potential effect modification by age was assessed using likelihood ratio test.ResultsAdolescents exposed to physical abuse by others, sexual abuse by peers, parental separation/divorce, bullying, or who had witnessed violence, were more likely to report non-daily toothbrushing compared with those with no exposure to the given ACEs. Each cumulative increase in ACE exposure was associated with a 30% higher likelihood of non-daily toothbrushing (OR 1.30, 95% CI 1.19–1.42). Similarly, increasing number of adversities were associated with both higher dentine caries experience (IRR 1.06, 95% CI 1.02–1.09) and higher enamel caries (IRR 1.07, 95% CI 1.03–1.11). This effect was modified by age (13–15 vs. 16–17 years) for dentine caries experience. Furthermore, there was evidence of effect modification by age with bully victimization for both toothbrushing frequency (Pinteraction = 0.014) and dentine caries experience (Pinteraction < 0.001). Specifically, bully victimization was associated with a higher likelihood of non-daily toothbrushing (OR 2.59, 95% CI 1.80–3.72) and higher dentine caries experience (IRR 1.30, 95% CI 1.14–1.50) among 16–17-year-olds.ConclusionsSeveral specific ACEs were associated with non-daily toothbrushing and a higher caries experience among Norwegian adolescents in the Young-HUNT4 Survey.

Investigating dual harm and misconduct in Northern Ireland: A 1‐year follow‐up

AbstractPurposeThis study investigates whether men who engage in dual harm while imprisoned are disproportionately involved in committing misconduct during a 1‐year follow‐up period. It also examines whether dual harm is significantly associated with future involvement in misconduct, when other known risk factors for misconduct are considered, and whether this relationship varies depending on the type of misconduct examined.MethodsDrawing on the administrative records of 430 men who were imprisoned during the 1‐year follow‐up period, a combination of descriptive statistics and negative binominal regressions was used to analyse the data.ResultsRoughly one‐in‐four men engaged in dual harm while imprisoned and were responsible for over half of all misconduct incidents recorded during the follow‐up period. A significant relationship between dual harm, as well as violence‐only harm compared to no harm, and future involvement in misconduct was also observed even when other known risk factors for misconduct were considered but only for violent and disorder‐related misconduct, demonstrating this relationship varied by harm history and type of misconduct examined.ConclusionThese findings address previous gaps in knowledge, advancing our understanding of the relationship between dual harm and misconduct. Possible explanations for why, compared to no‐harm history, dual harm as well as violence‐only harm was only related to violent and disorder‐related misconduct are offered, alongside possible implications of this research for policy and practice.

Age- and sex-specific hospital bed-day rates in people with and without type 2 diabetes: A territory-wide population-based cohort study of 1.5 million people in Hong Kong.

Type 2 diabetes affects multiple systems. We aimed to compare age- and sex-specific rates of all-cause and cause-specific hospital bed-days between people with and without type 2 diabetes. Data were provided by the Hong Kong Hospital Authority. We included 1,516,508 one-to-one matched people with incident type 2 diabetes (n = 758,254) and those without diabetes during the entire follow-up period (n = 758,254) between 2002 and 2018, followed until 2019. People with type 2 diabetes and controls were matched for age at index date (±2 years), sex, and index year (±2 years). We defined hospital bed-day rate as total inpatient bed-days divided by follow-up time. We constructed negative binominal regression models to estimate hospital bed-day rate ratios (RRs) by age at diabetes diagnosis and sex. All RRs were stratified by sex and adjusted for age and index year. During a median of 7.8 years of follow-up, 60.5% (n = 459,440) of people with type 2 diabetes and 56.5% (n = 428,296) of controls had a hospital admission for any cause, with a hospital bed-day rate of 3,359 bed-days and 2,350 bed-days per 1,000 person-years, respectively. All-cause hospital bed-day rate increased with increasing age in controls, but showed a J-shaped relationship with age in people with type 2 diabetes, with 38.4% of bed-days in those diagnosed <40 years caused by mental health disorders. Type 2 diabetes was associated with increased risks for a wide range of medical conditions, with an RR of 1.75 (95% CI [confidence interval] [1.73, 1.76]; p < 0.001) for all-cause hospital bed-days in men and 1.87 (95% CI [1.85, 1.89]; p < 0.001) in women. The RRs were greater in people with diabetes diagnosed at a younger than older age and varied by sex according to medical conditions. Sex differences were most notable for a higher RR for urinary tract infection and peptic ulcer, and a lower RR for chronic kidney disease and pancreatic disease in women than men. The main limitation of the study was that young people without diabetes in the database were unlikely to be representative of those in the Hong Kong general population with potential selection bias due to inclusion of individuals in need of medical care. In this study, we observed that type 2 diabetes was associated with increased risks of hospital bed-days for a wide range of medical conditions, with an excess burden of mental health disorders in people diagnosed at a young age. Age and sex differences should be considered in planning preventive and therapeutic strategies for type 2 diabetes. Effective control of risk factors with a focus on mental health disorders are urgently needed in young people with type 2 diabetes. Healthcare systems and policymakers should consider allocating adequate resources and developing strategies to meet the mental health needs of young people with type 2 diabetes, including integrating mental health services into diabetes care.

Homelessness Among People with Mental Illness - Using the Example of a Growing German City

The present study investigated the development of homelessness among people with mental illness using the example of a growing German city. Eight psychosocial community centres estimated how many of their clients had become homeless in the previous year of care from 2008 to 2019. A random effects negative binominal (RENB) regression model was developed to investigate the change of homelessness over time. The number of homeless, mentally ill clients of the psychosocial community centres increased significantly from 2008 to 2019 (IRR=1.26; 95-CI=1.16-1.36; p<.001). Every year, homelessness had an average increase of 26%. The problem of homelessness among mentally ill people has worsened in the investigated region during the past few years. Existing support services must be assessed and community-based support services expanded.

Factors Influencing the Preference for Homes as the Location for Long-term Care in the Japanese Population

Introduction: In this cross-sectional study, we aimed to investigate the factors for preferring homes as the location to receive long-term care in community-dwelling populations. Methods: A total of 4,113 individuals with a response rate of 36.7% from four areas in Japan were analyzed. All information was obtained from a questionnaire survey conducted in 2019. We used negative binominal regression modeling with adjustments for areas to calculate the prevalence ratios (PRs) and 95% confidence intervals (CIs) for the preference of long-term home care about factors. All missing values were input using multiple imputations. Results: The results show that the prevalence of preferring homes as the location for receiving long-term care was 73.4%. Being employed (PR: 1.04; 95% CI: 1.00–1.09), living with others (PR: 1.12; 95% CI: 1.05–1.19), feeling satisfied with the environment of nursing care in residential areas (PR: 1.05; 95% CI: 1.00–1.10), feeling satisfied with the natural surroundings in the community (PR: 1.18; 95% CI: 1.07–1.31), the presence of people in the community who can be consulted about problems (PR: 1.05; 95% CI: 1.00–1.10), and the presence of close friends in the community (PR: 1.09; 95% CI: 1.03–1.15) were significantly associated with the preference for long-term home care. Conclusion: We suggest that municipalities should consider these social and interpersonal associations to support older residents’ preference of receiving home care services.

67-OR: Examining the Association between Health Care Utilization and Race/Ethnicity in U.S. Adults with Diabetic Kidney Disease—2000–2020

Background: No recent national estimates have examined overall trends in health care utilization in adults with diabetic kidney disease (DKD) or the association between DKD health care utilization and race/ethnicity. This study sought to fill this current gap in knowledge. Methods: Medical Expenditure Panel Survey data (2000-2020) for adults with DKD was used for this analysis. The dependent variable was total health care utilization for the calendar year for each individual including office-based medical provider, hospital outpatient, emergency room, inpatient hospital, pharmacy, dental, and home health care visits. The primary independent variable was race/ethnicity. Mean health care utilization by DKD status was estimated and negative binominal regression was used to estimate Incident Rate Ratios (IRR) for health care utilization while adjusting for demographics, comorbidities, and time. Stata version 17 was used with a significant p-value set at &amp;lt;0.05. Results: After full adjustments, African American (IRR 1.20 95% CI 1.09 - 1.31) and Hispanic (IRR 1.15 95% CI 1.04 - 1.28) adults with DKD had significantly higher rates of total health care utilization compared with Whites. In addition, African American adults with DKD had significantly higher rates of office visits (IRR 1.10 95% CI 1.01 - 1.20) and outpatient visits (IRR 1.41 95% CI 1.14 - 1.75) compared with Whites and lower rates of dental care visits (IRR 0.74 95% CI 0.61 - 0.89) and prescription utilization (IRR 0.83 95% CI 0.78 - 0.88) compared with Whites with DKD. Further, over time adults with DKD had higher mean total health care visits (17.0 - 23.6) compared with 8.8-10.4 visits in adults without DKD. Conclusions: Our findings show that compared with individuals without DKD, individuals with DKD had significantly higher health care utilization from 2000 to 2020 and racial differences in health care utilization exists and persists over this period. Disclosure M.N.Ozieh: None. A.Z.Dawson: None. J.S.Williams: None. L.E.Egede: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R21DK131356 to M.N.O.), (R01DK118038, R01DK120861 to L.E.E.); National Institute on Minority Health and Health Disparities (K23MD016448 to M.N.O), (R01MD013826 to L.E.E.)

The epidemiology of acute methamphetamine toxicity presenting to emergency departments in Hong Kong

Introduction: Recreational use of methamphetamine is increasing worldwide, but epidemiology studies from Asia are lacking. We aimed to characterise the trends, drug use pattern, clinical presentations and health services utilisation of acute methamphetamine toxicity presenting to emergency departments and the current practice of emergency department psychosocial interventions in Hong Kong. Methods: This was a secondary analysis of a retrospective study on emergency department patients reported to the Hong Kong Poison Information Centre between 2010 and 2019 for acute toxicity related to recreational methamphetamine use. We studied the trend using a negative binominal regression model. Results: During the study period, 1225 episodes (involved 979 patients; 68.9% men; with a median age of 33.0 years) were reported. Acute methamphetamine toxicity did not increase significantly (odds ratio = 1.10, 95% confidence interval = 0.86–1.40, p = 0.46). Polysubstance abuse predominated. Many patients developed hypokalaemia (24.0%), rhabdomyolysis (17.2%), acute kidney injury (9.4%) and myocardial injury (4.7%); psychotic symptoms including auditory hallucination (23.8%) and paranoid delusion (21.1%); various acute behavioural disturbances and injuries. Overall, 66 patients required intensive care and 14 patients died. Only a minority of the patients were referred to social workers and voluntary drug treatment and rehabilitation services. Conclusion: Methamphetamine has a significant impact on physical and mental health in Hong Kong. Our findings highlight the need for screening for hypokalaemia, rhabdomyolysis, acute kidney injury, myocardial injury and psychosis in methamphetamine users and support policies that address polysubstance abuse, prevent drug use through continued public education and strengthen the referral system by integrating substance abuse services at the emergency department.

Campus environmental quality and streetscape features related to walking activity

ABSTRACT Many college students have adopted sedentary and physically inactive lifestyles, leading to obesity, diabetes, and other epidemics. Improving campus walkability can promote students’ walking activities and health conditions. This study aims to explore the influence of street-level environmental walkability attributes on campus pedestrian activity in a developing country, and thus present physical activity and health promotion campus planning and design strategies. Based on the Urban Design Quality theory, we use field audit to measure five environmental qualities and 23 types of streetscape features at eight Chinese university campuses. Several negative binomial regression models, without spatial autocorrelation, are fitted to analyze the effect of campus micro-scale walkability environmental attributes on pedestrian volume in different types of campuses. We found that environmental qualities and street space part streetscape features significantly affect pedestrian volume. Pedestrian-oriented campus planning strategies are presented based on the results.

Post-intensive care syndrome in primary care: The development of new diseases and primary care services utilisation – a prospective cohort study

BackgroundPatients experience long-lasting health problems defined as post-intensive care syndrome (PICS) after Intensive Care Unit (ICU) admission. Little is known about PICS in primary care.ObjectivesTo investigate whether ICU survivors encounter more new International Classification of Primary Care-2 (ICPC-2) diagnoses and general practitioner (GP) contact compared to patients with similar comorbidity without ICU admission.MethodsProspective multicentre cohort study in three Dutch general practices. Numbers of disease-episodes and GP contacts of ICU survivors ≥ 16 years admitted between 2008 and 2017 were extracted from GPs’ information systems. A non-ICU reference cohort was matched 1:1 for age, sex, follow-up period and comorbidity groups from patients’ medical history. Negative binominal regression analysis was used to compare both cohorts 0–3, 3–6, 6–12 months, 1–2 and 2–5 years after ICU admission and 1 year prior to admission.ResultsICU survivors (n = 199) encountered more new disease-episodes 1 year before (mean 3.97 (95% confidence interval [CI] 3.50–4.52]]; reference 2.36 [1.28–3.17]) to 2–5 years after ICU admission (3.65 [3.15–4.26]; reference 2.86 [2.52–3.22]). ICU survivors also had more GP contacts 1 year before (mean 19.61 [17.31–22.17]; reference 10.02 [7.81–12.38]) to 2–5 years after ICU admission (18.53 [15.58–21.85]; reference 12.03 [10.33–13.91]). Patients with prior ICU admission did not encounter patterns in specific ICPC-2 chapters compared to non-ICU patients.ConclusionPatients admitted to the ICU encounter more new primary care disease-episodes and GP contacts. As patients present their symptoms to their GP first, it is therefore up to the GP to recognise these critical illness-related symptoms.

Contamination Levels and Phenotypic and Genomic Characterization of Antimicrobial Resistance in Escherichia coli Isolated from Fresh Salad Vegetables in the United Arab Emirates.

Contaminated fresh produce has been identified as a vehicle for human foodborne illness. The present study investigated the counts, antimicrobial resistance profile, and genome-based characterization of Escherichia coli in 11 different types of fresh salad vegetable products (n = 400) sampled from retailers in Abu Dhabi and Dubai in the United Arab Emirates. E. coli was detected in 30% of the tested fresh salad vegetable items, with 26.5% of the samples having an unsatisfactory level (≥100 CFU/g) of E. coli, notably arugula and spinach. The study also assessed the effect of the variability in sample conditions on E. coli counts and found, based on negative binominal regression analysis, that samples from local produce had a significantly higher (p-value < 0.001) E. coli count than imported samples. The analysis also indicated that fresh salad vegetables from the soil-less farming system (e.g., hydroponic and aeroponic) had significantly (p-value < 0.001) fewer E. coli than those from traditional produce farming. The study also examined the antimicrobial resistance in E. coli (n = 145) recovered from fresh salad vegetables and found that isolates exhibited the highest phenotypic resistance toward ampicillin (20.68%), tetracycline (20%), and trimethoprim-sulfamethoxazole (10.35%). A total of 20 (13.79%) of the 145 E. coli isolates exhibited a multidrug-resistant phenotype, all from locally sourced leafy salad vegetables. The study further characterized 18 of the 20 multidrug-resistant E. coli isolates using whole-genome sequencing and found that the isolates had varying numbers of virulence-related genes, ranging from 8 to 25 per isolate. The frequently observed genes likely involved in extra-intestinal infection were CsgA, FimH, iss, and afaA. The β-lactamases gene blaCTX-M-15 was prevalent in 50% (9/18) of the E. coli isolates identified from leafy salad vegetable samples. The study highlights the potential risk of foodborne illness and the likely spread of antimicrobial resistance and resistance genes associated with consuming leafy salad vegetables and emphasizes the importance of proper food safety practices, including proper storage and handling of fresh produce.